1. Field of the Invention
The invention relates to surgical instruments. More particularly, the invention relates to an apparatus for the automatic remote control of endoscopic surgical instruments such as endoscopic biopsy forceps devices.
2. State of the Art
Endoscopic surgery is widely practiced throughout the world today and its acceptance is growing rapidly. In general, endoscopic surgery involves the use of a camera or optical system inserted through a tube, while a cutter, dissector, or other surgical instrument is inserted through another tube for purposes of manipulating and/or cutting an internal organ or tissue under view of the surgeon via the camera or optical system. In endoscopic biopsy procedures, typically, the camera or optical system is located in one lumen of a flexible endoscope while a biopsy cutter is placed through another lumen thereof.
By 1996, it is expected that more than two million additional endosurgeries will be performed per year that, in 1990, were done via open surgery (MedPRO Month, I:12, p. 178). The advantages of endoscopic surgery are clear in that it is less invasive, less traumatic, and recovery is typically quicker. As a result, many new instruments and devices for use in endosurgery are introduced every year. Most endoscopic instruments have similar configurations with a proximal handle, an actuation mechanism, and distal end effectors coupled by a tube through which the actuation mechanism extends. (As used herein, "proximal" means closest to the surgeon and farthest from the surgical site, while "distal" means farthest from the surgeon and closest to the surgical site.) The end effectors take many forms such as grippers, cutters, forceps, dissectors and the like.
Endoscopic instruments in use today may be broadly classified as two types: reusable; and disposable. Parent application Ser. No. 08/042,606 and the parent thereof, Ser. No. 08/016,596 relate to a third type of endoscopic instrument which is separable into a reusable portion and a disposable portion.
A number of different types of biopsy forceps are in common use, typically in conjunction with endoscopic assistance. These devices most often include sharp opposing jaws for grasping and tearing tissue for biopsy. The jaws are mated with one another about a clevis pin which is mounted in a clevis. The clevis extends into a housing which is crimped to the distal end of a relatively long flexible coil. The proximal end of the coil is coupled to a handle having means for articulating the jaws. The handle generally includes a central slotted shaft about which a spool is disposed. One or more pull wires from the jaws extend through the coil and are attached to the spool while the coil is attached to the central shaft of the handle. Movement of the spool relative to the central shaft moves the pull wires relative to the coil and thus articulates the jaws at the distal end of the coil. The handle is usually provided with a thumb ring at its proximal end. Movement of the spool relative to the handle is effected by inserting a thumb through the thumb ring, surrounding the spool with two fingers, and moving the thumb relative to the fingers in an action similar to operation of a hypodermic syringe. Although it is possible to operate the forceps in other ways, accurate operation generally requires the use of three digits.
When using the forceps, the jaws and coil are inserted through a flexible endoscope which is already in place in the patient's body. The surgeon holds the endoscope while viewing the biopsy site through the optical system and guides the coil and jaws to the biopsy site while a nurse holds the handle. When the surgeon has located the jaws at the appropriate place, the nurse is instructed verbally to operate the handle to articulate the jaws and grasp a biopsy sample. Because both of the surgeon's hands are occupied holding the endoscope and the coil of the forceps, the surgeon cannot operate the forceps directly. As a result, a biopsy procedure utilizing an endoscopic biopsy forceps requires the time and presence of, and room for two skilled practitioners instead of one.